I always see the healthcare cost to consumer compared to other countries, but that isn't the true cost to society if the govt is subsidizing the rest. AFAIK the US healthcare is still truly more costly. Monopolies or something, idk.
Americans also consume a lot more healthcare. And doctors and nurses earn 2x more than in other countries. An NHS nurse makes something like $33k a year. In the US it's going to be $60-70k before overtime.
I'd be curious to see what portion of US health care goes to salaries of licensed health care workers, and how the relates to labor costs of various middle men and administrators, as well as regulatory compliance people.
Administration costs have gone something like 4x since 1980. The specific share they take is probably dependent on the niche, but like universities, a huge portion of cost is siphoned away to paper pushing.
The only time I've seen a doctor since I've been responsible for health insurance was when the police took me there in handcuffs against my will and without a court order or any legal basis. Obviously on that occasion I refused to provide insurance. I've never been to the doctor voluntarily as an independent adult or paid a deductible for my healthcare. Can you explain how the deductible relates and is useful for figuring doctor's pay?
When you see a doctor when you have insurance you have to pay an out of pocket fee. Because economics teaches us that patients needs skin in the game otherwise people will abuse 'free healthcare'. This makes total sense if you're an economist. Because well if you are an economist you are an extremely stupid person.
Now if you're an accountant you'd take 20 patients a day X 250 working days a year X $50 and get $250,000. Which is close or more than a doctors take home.
That still mixes a lot of factors in, including how often people need care and what kind of care is provided. Better to compare the same procedure/drug/etc in the US vs elsewhere. I think in the US it's usually more costly that way, especially when it comes to drugs.
> healthcare per capita than any other OECD nation.
You also need to mention that the US is not like any other OECD nation. It also happens to he the nation with the largest innovation in Healthcare, and not just by a little. By Far.
there's no discernible innovation in healthcare, at least if you go by any actual metric that would indicate that. Life expectancy in Cuba is higher than in the US, infant mortality in the US is higher than in any peer country, drug death rates are higher than in most if not all comparable nations, and so on.
The pharmaceutical industry might produce innovations concerning some rare diseases or whatever, but there's no discernible reason why that is, or should be paid for by the public healthcare sector.
You have to be careful with statistics like that. I did some research on that a few years ago. Different countries define infant mortality differently. Other countries would classify many failed pregnancies as a miscarriage that the US classifies as infant mortality, for example. This is because the US is very aggressive at trying to save premature babies.
Yes, and much of that small, single-digit percentage of charity hospital expenses will be that sort of care. It's a rounding error on their books. Stitches are costly whether you're in the ER or in the ICU after surgery. Forcing poor folks to rely on the ER for treatment is silly, and needlessly expensive, but it's hardly the primary driver of healthcare cost rises.
Heavily is something of a stretch: the NIH is a fairly small part ($40B) of the federal budget ($1,600B discretionary + another $4,000 mandatory spending).
It's about 0.5% of the total budget, which works out to about a dollar a week for the average taxpayer. On top of that R&D spending has a huge multiplier: a lot of that money supports small, high-tech businesses, which in turn hire people...etc
I never claimed it was a huge part of the federal budget, only that NIH and NSF provide a large fraction of basic science research. It’s always tricky tracing that to actual treatments but the drug companies tend to fund development of promising candidates from taxpayer-funded basic research more than doing that basic science themselves, and a lot of their R&D goes to tweaking existing drugs which might make them more effective/convenient but definitely protects the company’s margin against generics.
Less so after you correct for all of the things which we have to pay for out of pocket: health insurance, copays, drugs, etc. but also things like education, childcare, retirement, transportation, and often housing. I’ve known a number of people from Europe or Asia and all of them commented on how they thought they’d be making more here based on the raw income numbers, and how much more stressful it was here because you had to do more work yourself to get the same or lesser quality.
A lot of those things are based on life circumstances. If you have a large family in a major metropolitan area making the median income then yeah you might be worse off.
If you are a tech worker in a small city or town then it can be quite lucrative. You have a lot of control over these variables, especially when younger.
>Less so after you correct for all of the things which we have to pay for out of pocket: health insurance, copays, drugs, etc. but also things like education, childcare, retirement, transportation, and often housing.
You end up paying for those things in other countries where you're provided them but not directly charged for it. The difference is in the USA for most of those if you don't pay you simply don't get the service, while in other countries you get the service but the tax-man may come and put you in jail if you don't pay for them. It's an individual choice but I prefer getting to pick (at least a little bit) how to spend that money personally rather than the government entirely deciding for me, although I can see how someone coming from a place where government does all that would find it uncomfortable.
But that’s the point: you’re already paying more in taxes for healthcare than anyone else in the world, and then you’re paying again to an insurance company. You’re literally paying twice.
So I buy health insurance and save money however I choose for later expenses. I don't see how it's easier or less stressful to bring the government into that loop, unless I don't care at all.
It’s all the stuff you left out: for example, you’re spending on average 2-3 times more so you’re probably not actually saving more.
Finding providers will require you to spend a lot of time finding doctors, dentists, specialists, etc. who you like, accept your insurance, and are accepting patients. Often the intersection of those things requires substantial travel to areas without transit so how that whatever medical needs you develop don’t preclude driving.
If you did have any real medical needs - even common life events like an uncomplicated natural pregnancy – you’ll need to have tens to hundreds of thousands of dollars saved to avoid needing to negotiate a payment plan. That’s even more pricey if you need medication or care for an ongoing basis.
Because the doctors are for-profit, you’re going to be steered towards unnecessary services and you’ll need to review every bill to make sure only things you approved are listed - hospitals are notorious for having some random out-of-network specialist pop in for 30 seconds to add $15k to your bill.
Because your insurance company is for-profit, be prepared to need to escalate or threaten to sue to have necessary treatment authorized. Your doctor’s medical expertise is secondary to Fred in claims processing, hope whatever you have doesn’t get worse in the meantime!
Also because your doctor and insurance company are for-profit, expect either of them to stop doing business with the other any time it’s more profitable. There’s no guarantee that anyone in-network will be available in your area and you’ll likely need to haggle to get permission to go out of network.
None of that is great to deal with while your family is caring for someone with whatever issues need testing and it’s made even more fun by the knowledge that almost nobody in what you’d consider a peer country has to deal with anything like that much hassle.
> It’s all the stuff you left out: for example, you’re spending on average 2-3 times more so you’re probably not actually saving more.
What I spend on health insurance is far less than the difference in pay I'd get working in a peer country as a SWE, even if ignoring the difference in taxes. I'm not saving up tens of thousands of dollars for common life events; it's covered.
And the opportunities are better here. My family members and friends from Iran and Lebanon tell each other, France or Germany is better if you want to sit on an entry-level job (which some do), US is better if you're ambitious. There's a real brain drain.
It matters when you're talking about policy. Subsidizing healtchare doesn't fix the problem of anticompetitive behavior among the suppliers, or pushing unnecessary treatment/drugs.
